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Post-hepatectomy Liver failure (PHLF) - Dreaded complication of a difficult surgery

Is there a unifying definition of PHLF?

What are the preventive strategies?

How best can it be managed?

Lets dive right in! Bookmark this thread 🧵

#MedTwitter Leading cause of post-hepatectomy mortality

Rx Challenges?

🧩 Heterogeneity- Lack of uniform diagnostic Cx despite ISGLS Defn(2001)- variations prevalent

🧩 Predictability- Accurate preop predictions difficult

🧩 Therapy- No effective Rx once PHLF occurs

🚨 Prevention 🚨

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Should cancers of the esophagogastric junction be managed as esophageal cancers or gastric cancers?

What is the adequate lymphadenectomy template?

NACTRT vs FLOT?

Are they a different entity altogether requiring a unique approach?

Lets explore…🧵 Why the discussion?

🧿 ⬆️ Incidence due to ⬆️ obesity & GERD

🧿GEJ is a histological transition zone from squamous to columnar ep. Tumours here can drain to lymph nodes above &/or below

🧿Locally-advanced Ca - Pre-operative chemo-radiation or peri-operative chemotherapy?

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Do you know why Total Neoadjuvant therapy #TNT in locally advanced #RectalCancer (LARC) is getting so much attention?

Bookmark this thread 🧵- your own TNT🧨💣 ready reckoner!

#MedTwitter @me4_so @somedocs @PColorectal @ASCRS_1 @ESSOnews @escp_tweets @Cirbosque SURGERY is still the definitive curative treatment in patients who don’t achieve clinical complete response and are not on the Wait and watch protocol.

The TNT protocol aims to deliver systemic and locoregional therapy all-in, before definitive surgical management.

It's the end of a very significant year and what an year it has been for me! Apart from all the other things that happened, here are some positive and good things to remember.

Much to be grateful, thankful and happy about !

Wish to share this with you all. 🤗 The bond year @TataMemorial after residency where you put into practice what you learnt painstakingly for the preceding 3 years. Fruits of hard earned skills and knowledge. And I savoured them @TMC_Varanasi. Nothing short of a surgical temple for me after @TataMemorial, Mumbai.

Learnings from a speciality residency at one of d top institutes in India -

In my last month of residency & 1-yr post-MCh bond as an adhoc Asst Prof at @TataMemorial Mumbai & @TMC_Varanasi here's a thread on what I learnt. (Might hv some snippets I wish I knew before I joined) 1. Oncology - To me, treating #CANCER is the highest form of medicine currently practised. If a fellow human being, is able to rid another, of d #EmperorOfAllMaladies, medicine shall hv achieved what it set out to. Cancer still lurks in d realm of that which needs 'conquering'